Lapas attēli
PDF
ePub

[3-026.]

WAR OF 1812.-DECLARATION OF A WIDOW FOR PENSION UNDER

ACT OF FEBRUARY 14, 1871.

SS:

[ocr errors]
[ocr errors]

; on the

[ocr errors]

on the

[ocr errors]
[ocr errors]

STATE OF

County of On this day of

A. D. one thousand eight hundred and ninetypersonally appeared before me

of the

a court of record within and for the county and State aforesaid,

aged — years, a resident of county of State of who, being duly sworn according to law, declares that she is the widow of

who served the full period of sixty days in the 1. service of the United States in the war of 1812; and who was the identical

who2
in Captain

-'s company, regiment, brigade, division, at

day of 181-, and was honorably discharged at

on the

day of 181-; that 3. ; that she was married under the name of

to said

day of
18—, by

at

county of

State there being no legal barrier to said marriage; that her said husband died at

day of

18—, and that she has not remarried since his death; that at no time during the late rebellion against the authority of the United States did she or her said husband adhere to the cause of the enemies of the Government, giving them aid or comfort, or exercise the functions of any office whatever under any authority, or pretended authority, in hostility to the United States ; that she will support the Constitution of the United States; that she is not in receipt of a pension under any previous act; that she makes this declaration for the purpose of being placed on the pension roll of the United States under the provisions of the act approved February 14, 1871, and hereby constitutes and appoints, with full power of substitution and revocation

of her true and lawful attorney to prosecute her claim and procure the issuance of a pension certificate to her. That her post-office address is county of State of and her domicile or place of abode is

on the

[ocr errors]
[ocr errors]

[Applicant.]

[Witnesses.]

Also personally appeared

residing at, and

residing at persons whom I certify to be respectable and entitled to credit, and who, being by me duly sworn, say they were present and saw

the claimant, sign her name (or make her mark) to the foregoing declaration; that they have every reason to believe, from the appearance of said claimant and their acquaintance with her, that she is the identical person she represents herself to be; and at no time during the late rebellion against the authority of the United States did she, or her said husband, adhere to the cause of the enemies of the Government, or give them aid or comfort; and that they have no interest in the prosecution of this claim.

[Signatures of witnesses.]

1“ Military” or “naval.”
2“Was drafted," "enlisted,” or “was enrolled."

3 Here give place, capacity, and manner of service, and any historical events in the war in which he participated, or with which he was connected.

[ocr errors]

Sworn to and subscribed before me this

day of

A. D. 189-, and I hereby certify that the contents of the above declaration were fully made [L. S.] known and explained to the applicant and witnesses before swearing, in

cluding the words erased and the words added; and that I have no interest, direct or indirect, in the prosecution of this claim.

[blocks in formation]

By an act of Congress approved February 14, An honorable discharge from the rvice in 1871, pensions at the rate of $8 per month are all cases is necessary. granted to the officers and enlisted and drafted Declarations of these claimants must be made men (both militia and volunteers) of the mili- before a court of record, or before some officer tary and naval service of the United States in thereof having custody of its seal, said officer the war of 1812 who served for a period of sixty being fully authorized and empowered to addays, and to the widows of those who have died minister and certify any oath or affirmation rewho were married prior to the treaty of peace iating to any pension or application therefor. (February 17, 1815) which terminated said war. The claimant's identity and loyalty must be Also to such officers and soldiers who served proven by two witnesses, certified by the judiless than sixty days who have been personally cial officer to be respectable and credible, who named in any resolution of Congress for any are present and witness the signature of the specific service in said war.

declarant, and certify to his identity and loy. Under this act three classes of claims will alty under oath or affirmation. arise:

The declaration must recite the name, age, First. Of officers, soldiers, and sailors, who and residence of claimant; whether married or served for sixty days, who have never been pen- unmarried; that the term of service was the sioned for a disability incurred in the service of full period of sixty days; or that he has been the United States. These will be entitled to a full mentioned in a resolution of Congress, giving pension of $8 per month from February 14, 1871. date of resolution; the place and time of enlist

Second.–Of officers, soldiers, and sailors, who ment and discharge, and the company, regiserved for sixty days, but who are in receipt ment, brigade, and division in which he served; of a pension for disability incurred in the serv- the places, capacity, and manner of service, and ice of the United States. These will be enti- his participation in, or connection with, any tied to an increase of their pension to $8 per historical event of the war are particularly demonth from February 14, 1871.

sired to be mentioned. Third.-Of widows of officers, soldiers, and The declaration must also contain the followsailors who served sixty days who were mar- ing oath: ried to the soldier prior to the treaty of peace That I (if a widow, “That neither I nor my which terminated said war (February 17, 1815), said husband”) at no time during the late reand who have since remarried. These will not be bellion against the authority of the United entitled to $8 per month from February 14, 1871. States, adhered to the cause of the enemies of

If the term of service was less than sixty days, the Government, giving them aid or comfort, there is no claim for pension under this act, un- or exercised the functions of any office, under less the person who served has been personally any authority, or pretended authority, in hosmentioned in a resolution of Congress for some tility to the United States, and that I will supspecific service in said war; in which case he or port the Constitution of the United States." his widow is entitled to the same benefits under its provisions as though he had served the full period of sixty days.

[blocks in formation]

CLAIM OF WIDOW FOR SERVICE PENSION UNDER THE PROVISIONS OF SECTIONS 4736 TO 4740 (INCLUSIVE), REVISED STATUTES, AND THE ACT OF MARCH 9TH, 1878.

[N. B.-All the blank spaces in this form must be carefully filled up in accordance with the instructions on the back hereof, and from the best information possessed, or obtainable, by the applicant.]

[ocr errors]
[ocr errors]
[ocr errors]

-, in the

com

[ocr errors]
[ocr errors]
[ocr errors]
[ocr errors]

STATE OF County of
On this day of A. D. one thousand eight hundred and

; personally appeared before me,

the same being a court of record within and for the county and State aforesaid, (1) -, aged

years, a resident of in the State of - who, being duly sworn according to law, declares that she is the widow of (2)

deceased, who was the identical (3) who served under the name of (4)

as a (5)

in the company commanded by Captain

Regiment of manded by

in the war of 1812; that her said husband (6) at on or about the

day of
A. D.
for the term of

and continued in actual service in said war for the term of (7) and whose seryices terminated, by reason of (8) at

on the

day of A. D. Shefurther states that the following is a full description of her said husband at the time of his enlistment, viz: (9)

She further states that she was married to the said at the city (or town) of

in the county of and in the State of

day of

A. D. — by one (10) who was a (11) and that her name before her said marriage

; and she further states that (12) and that her said husband (13) died at —, in the State of

- day of A. D. -, and that she has not again married; and she further declares that the following have been the places of residence of herself and her said husband since the date of his discharge from the Army, viz: (14)

She makes this declaration for the purpose of obtaining the pension to which she may be entitled under sections 4736 to 4740 (inclusive), Revised Statutes, and the act of March 9th, 1878, and hereby appoints

of

her true and lawful attorney to prosecute her claim; and she further declares that she has heretofore made application for (15) and that her residence is No. street, city (or town) of county of State of

and that her post-office address is

on the

[ocr errors]
[ocr errors]
[ocr errors]

:

was

on the

[ocr errors]
[ocr errors]
[ocr errors][merged small][merged small]
[ocr errors][ocr errors]

Also personally appeared

aged years, residing at No.
street, in
and

aged years, residing at No. street, in persons whom I certify to be respectable and entitled to credit, and who, being by me duly sworn, say that they have known the said

for
years and for

- years, respectively; that they were present and saw her sign her name (or make her mark) to the foregoing declaration; that they have every reason to believe, from the appearance of said claimant and their acquaintance with her, that she is the identical person she represents herself to be; and they further say that they are able to identify her as the person who was

[ocr errors]

the wife of the identical (16)

who rendered the service alleged in the above application (in the company of Captain

in the regiment of

in the war of -) by the following-named facts and circumstances, viz, (17) and that they have no interest in the prosecution of this claim.

[ocr errors]

[Signatures of witnesses.] Sworn to and subscribed before me this day of -, A. D. 18—; and I hereby certify that the contents of the above declaration, etc., were fully made known and explained to the applicant and witnesses before swearing, including tho words erased, and the words added; and that I have no interest, direct or indirect, in the prosecution of this claim.

[ocr errors]
[blocks in formation]

NOTES. 1 Here allege full name of applicant. 2 Here allege full name of soldier. 3 Here allege again the name of soldier. 4 Here allege the name under which the soldier served. 5 Here allege the rank under which the soldier served. 6 Here state "enlisted," "volunteered," or "was drafted," as the case may be.

? Here state the number of days or months of service rendered by the soldier; fourteen days being the shortest period for which service pension is by law allowed, unless the soldier was actually engaged in a battle. If the claim is made for battle service the blank should be so varied as to allege such service in addition to the allegation of term of service. 8 Here insert the words "an honorable discharge,” or “death," as the case may be.

9 Here let a full description of soldier follow, giving age, occupation, birthplace, height, color of hair, eyes, and complexion, and any other particulars as to description.

10 Here allege the name of the person who performed the marriage ceremony. 11 Here state the official character of the person who performed the ceremony; i.e., whether a minister of the gospel or a justice of the peace, &c.

12 Here state whether the claimant or her husband (the soldier) had been previously married; and if either had, the name of the former husband or wife should be stated; and the date and place of the death of, or divorce from, the former consort should be alleged.

13 Here insert the name of the husband on account of whose service and death the claim is made.

14 Here state all the places of residence; if in a city, giving the street and number; and from and to what dates he resided at each place.

15 If any application for bounty land or pension has previously been made, state the fact here, giving the date, and number if possible, and the act of Congress under which the claim was made; and designating whether it was a claim for bounty land or pension, and whether a warrant for the land or certificate for the pension was ever issued.

:6 Here insert the name of the soldier.

17 Here name all the facts nd circumstances which enable the witnesses to swear, from a personal knowledge, that the claimant is the widow of the identical person who rendered the service alleged in the claim.

All services rendered by the soldier in the war for which claim is made, or in any other war, with the names of officers in each service, must be given in the application. If this blank is used, it will be useless to fill the spaces relating

to the appointment of attorneys. If the service was rendered as a substitute, the name of the principal for whom the substitute served should be given.

[3_037.]

MEXICAN WAR PENSION.

[Act of January 29, A. D. 1887.) DECLARATION OF SURVIVOR FOR PENSION.

[ocr errors]
[ocr errors]

as

a

STATE OF County of
On this day of

A. D. one thousand eight hundred and ninety, personally appeared before me,

a resident of in the county of in the State of who, being my me first duly sworn according to law, deposes and says: I am the identical

who served under the name of in the company commanded by Captain — in the regiment of

[if in naval service, name vessel, etc.), commanded by in the war with Mexico; that I enlisted at on or about the

day of

A. D. for the term of and was honorably discharged at

on the day of

A. D. 18–

First group of facts which will entitle to pension. That being duly enlisted, as aforesaid, I actually served sixty days with the Army or Navy of the United States in Mexico, or on the coast or frontier thereof, or en route thereto, in the war with that Nation, which service was as follows:

[ocr errors]
[ocr errors]
[ocr errors]

18–

[ocr errors]

(a) That I am years of age, having been born at

on the day of

(or b) That I am dependent on others than those legally bound for my support for my livelihood; that I have been so dependent since and that the upon whom I am dependent is

of

who has afforded me the following support: [Here describe what has been done for your support.]

(or c) That I am disabled by reason of which said disability was not incurred while in any manner voluntarily engaged in aiding or abetting the late rebellion against the authority of the United States ; but that said disability was incurred at on or about the

day of
A. D.

in manner as follows:

Second group of facts which will entitle to pension. That, being so actually enlisted as aforesaid(a) That I am years of age, having been born at

on the

day of A. D. 184, (or b) I was actually engaged in battle with the enemy in the war with Mexico, to wit: In the battle of -, on the day of —, 18%.

(or c) That I am dependent on others than those legally bound for my support for my livelihood; that I have been so dependent since and that the upon whom I am dependent is

who has afforded me the following support: [Here describe what has been done for your support.)

( or d) That I am disabled by reason of which said disability was not incurred while in any manner voluntarily engaged in aiding or abetting the late rebellion against the authority of the United States, but that said disability was incurred at on or about the

day of -, 18—, in manner as follows:

of

[ocr errors]

Third group of facts which will entitle to pension. I was personally named in a resolution of Congress for a specific service in said war, to wit: In the resolution of the day of

18– (a.) That I am years of age, having been born at

on the day of

18–. (or b.) That I am dependent on others than those legally bound for my support for my livelihood. That I have been so dependent since and that the

[ocr errors]
[ocr errors]
« iepriekšējāTurpināt »